J. Marion Sims is a controversial figure in both the history of Alabama and early modern medicine. His experiments on enslaved women in Alabama and poor women in New York occurred without their ability to consent, dispute treatment options, or seek a different doctor.
In writing about him I have also committed a deep mistake in relying too heavily on his accounting of his life without consulting additional monographs on the topic or making mention of his intense ambition and desire for fame and fortune. Below are some links for further reading on the central issues of his medical ethics.
Part 5: “…with great heroism and bravery.”
J. Marion Sims left Mrs. Merrill’s home with a very basic understanding of how to dilate the human vagina. One could examine the inner workings of the vaginal canal by having a patient get onto her elbows and knees and letting the pressure of air naturally inflate it.
This changed everything.
Sims operated a small eight-bed hospital “in the corner of my yard.” The purpose of this separate hospital was to attend to the medical needs and surgeries of Montgomery’s free blacks and enslaved peoples. Recently several enslaved women were sent there from around Montgomery county with the same ailment.
Vesico-vaginal fistulas occurred during childbirth. The stresses involved severely damage the tissues of the pelvis and a hole, or fistula, opens between the bladder, AKA the vesico, and vagina proper. This leads to a constant stream of urine leaking directly into the vagina; causing further tissue damage, a highly unpleasant smell, and complications for the emotional health of the suffering woman.
Although several women were sent to receive treatment all previous medical knowledge indicated that no method might treat them. So Sims turned away each one in kind. However, a woman named Betsey still resided at the hospital, having only arrived a few days prior with her heavily pronounced fistula.
Armed with his new knowledge of the dilated vagina Sims rushed home. He stopped at a store called Hall, Mores & Roberts, where he “bought a pewter spoon,” to use in the examination. He summoned two medical students interning under him and finally arrived at the tiny hospital in the corner of his yard. The students ran behind him. One said, “[y]ou have got through your work early this morning.”
“I have done none of it!” shouted Sims.
Finally he appeared before Betsey and asked to examine her one more time before she left.
Imagine for a moment that you are her. You live under a brutal slave system, gave birth not even a few months ago, are separated from your child and meager support system, and after all this – you’ve traveled, under your own power, with a horribly uncomfortable condition to see a man who just yesterday said he could not help you. Suddenly, three white men burst through the door and the doctor is waving a spoon.
It’s a small miracle that she consented to the inspection.
Betsey turned over and rested her head on her hands. Sims positioned the medical students so that one might grab a buttock each. They pulled them apart and Sims inserted the spoon handle. He stared in awe as, “I saw everything, as no man had ever seen before.” This is either hyperbole or an indication of the undue influence of Victorian sexual mores upon medical knowledge. (226-234)
Either way, Sims immediately overestimated his skills as a surgeon. He exclaimed “there is nothing to do but pare the edges of the fistula and bring it together nicely.”
Let us once again imagine life as Betsey. You are beyond naked, two men that you do not know at all are holding your cheeks apart, and a madman is using a spoon to stare at your innards and mutter to himself. It would be hilarious if it weren’t so horrifying. After this gross violation of her person Betsey returned to the home of her enslaver, a man named Dr. Harris.
Sims felt that he was close to a surgical cure for the condition. He “ransacked the country for cases,” and eventually found about a half dozen enslaved women with vesico-vaginal fistulas who previously languished in obscure agony across the Black Belt.
After adding an entire extra story to his corner-hospital the doctor now had twelve beds for patients and four beds for servants to tend to their needs. At this point Sims named three of the women – Betsey, Lucy, and Anarcha – who served as patients, assistants, and surgical guinea pigs. As the women were enslaved, J. Marion Sims found himself forced to make contracts with each of their enslavers. In exchange for Sims boarding, feeding, and operating on the women; their owners agreed to clothe them and pay their associated taxes.*
In December 1845, Lucy suffered through the first operation. A dozen local doctors attended.
Sims “never dreamed of failure,” but quickly learned of his own foolishness. He found the base of Lucy’s bladder destroyed “and a piece had fallen out,” a gash, about two inches long, joined the bladder and the vagina and as a result she urinated constantly. The “tedious and difficult,” operation took place before anesthesia became common during surgery and Lucy soldiered through the pain “with great heroism and bravery.”
The fistula closed after about an hour of surgery. Sims used a combination of sponge and silk string to form a tube through which the urine might flow from the bladder into the urethra. The assembled doctors congratulated him and left.
The sponge, a bacteria ridden foreign object nestled between the urethra and the bladder, naturally filled with blood, urine, and pus. Over the course of five days it solidified and morphed into stone. Lucy fell ill and suffered intense fevers and blood poisoning. If Sims’s contraption remained inside of her much longer she would die.
Her dire condition forced an emergency operation. Sims pulled the sponge from her “by main force.” Lucy’s torment was “extreme” and her survival seemed uncertain. Fortunately she recovered and after an examination it appeared that much of her fistula healed from the application of sutures. Betsey received similar treatments with similar results. Although the actual size of the fistula closed it did not entirely heal, so that progress appeared while the solution remained elusive.
Of course, the worst fistula occurred in Anarcha. Let us pause for a moment and remember the 1836 malaria outbreak. When Sims leaned heavily against death’s door the only person who watched over him, from the sun’s first rays to the moon’s last glow, was a young enslaved girl named Anarcha. Suffice to say they’d met before. Hell, J. Marion Sims even helped to deliver her baby.
Nine years later they found their roles reversed. Now Sims tended to her maladies. Anarcha possessed a far more pronounced fistula than either Lucy or Betsey, the exterior wall of her vagina became greatly damaged during childbirth and the barrier between vagina and rectum torn asunder. Great streams of urine constantly soaked her legs and clothing, the flesh around her genitals burned and bubbled “almost like confluent small-pox,” and intestinal gases leaked from day and night. She suffered. Lord how she suffered.
After repeated surgeries neither Lucy, Betsey, Anarcha, nor the other women at the hospital experienced full relief. Sims managed to make small improvements here and there, but a small fistula is still a fistula. The years rolled on and the patience of other doctors soon waned. Eventually Sims stood alone “and at last I performed operations only with the assistance of the patients themselves.”
After four years of trial and error Sims stood closer to the goal, but felt farther away than ever. One night he stared at his ceiling until 3am contemplating sutures and ties and forceps and bladders. Forceps, yes, that was the solution. Enlivened by this revelation he woke his wife, Theresa, and told her of his plan.
By using a perforated suture – the contemporary medical practice of using a partially divided lead pellet, secured by strong compression, to tie off sutures inside the human body – with this combination of forceps and perforated shots he hoped to finally close the fistulas that haunted his patients and creeped in his mind.
In June 1849, Lucy suffered through the first perfected operation. Once again Sims used silk thread and once again she developed an infection. Not until he found “a little bit of brass wire” laying on the ground did it occur to him that a metal might suffice where a thread had failed. Sims went and spoke with the local jeweler, Mr. Swan, and requested silver wires be made that matched the little brass piece of trash in length and width.
When Sims chose silver for his new sutures, he knew that it worked, but did not understand the metal’s antibacterial properties.
That doesn’t matter right now. Right now it is 1849. Anarcha is prepped and ready for her thirtieth operation. J. Marion Sims examines his instruments one last time. Four silver wires are run through four perforated sutures and forceps are clamped together to form four perfect little knots.
In this moment there are two eras; childbirth before Anarcha’s surgery and childbirth after.
A week goes by and it is time to remove the sutures. She is lifted onto the operation table and a speculum inserted. “There was no inflammation, no tumefaction, nothing unnatural, and a very perfect union of the little fistula.”
Lucy and Betsey soon underwent the same operation. (236-246)
J. Marion Sims eventually left Alabama. He came to this state and made a name for himself and alighted away from this place to more haughty endeavors like the establishment of a women’s clinic in New York City and tours of Europe. His methodical approach evolved quickly and spread across the industrialized world. It soon attracted other physicians with other theories and became its own branch of medicine – gynecology.
Some semblance of Sims’s methods are still used today to fight the scourge of fistula across the developing world. Women who experienced traumatic childbirth might be healed by a single surgery and their lives greatly improved.
Accordingly, a statue of J. Marion Sims stands to this day in New York City’s Central Park.
Anarcha, Betsey, Lucy, and the other women at the little clinic “in the corner of [Sims’s] yard” did not get to leave Alabama. They did not receive plaudits nor commendations and unfortunately exist only in the memories of those who read Sims’s works. Indeed, once they received their cures they returned to life as an enslaved person. Yet they suffered, offered advice, assisted in surgeries, and were as much a part of the search for the cure as Sims himself.
Where’s their statue?
*I really hate using words like owner, master, or slave, because they tend to denote a categorical or occupational meaning in our language, and instead try to substitute words like enslaved and enslaver. This stems from my long-held belief that freedom is the innate condition of the human soul and that the slave system required persistent and pernicious action, on a daily basis, to sustain itself. Thus the use of the nominalized adjectives.
However, this raises a point about discussing my own history. Is it better to confront the uncomfortable language or to try and substitute a less bitter word that offers a better meaning? If you have any thoughts on this subject, make sure to comment on them below. Also, I know I’m being fairly irreverent about medical experimentation, but that’s more of a coping mechanism. I don’t think anyone would read this without a level of humor in it.
Sims, J. Marion. The Story of My Life. New York: D. Appleton and Company, 1884.